The value of parents' concerns to detect and address developmental and behavioural problems

Half of all children with disabilities are not identified before school entry. This precludes their participation in early intervention programs that have known benefit. Although screening tests can greatly improve detection rates, these have not been popular in primary care due to test length and time constraints, and difficulty managing children's behaviour. An alternative is to rely on information from parents. This review describes existing research on parents' concerns about children's development and behaviour. Hand- and electronic-searches were made of journals indexed in the EMBASE, Medline and Psych-lit data bases between 1980 and 1998. Key words included 'parents' concerns' and 'parents' complaints'. These terms were intersected with 'development' and 'behaviour'. The search identified 30 articles which were grouped into the following categories: frequency of concerns, concerns about development/behavioural/emotional status, the meaning of concerns, influences on concerns including children's ages, health, and parents' mental health status, eliciting concerns, how parents' respond to concerns questions, and the accuracy of parents' concerns. Parents, regardless of differences in education, socioeconomic status, and child-rearing experience, are able to raise concerns that accurately reflect children's developmental and behavioural status. However, concerns must be carefully and systematically elicited and interpreted according to available evidence. When this occurs, concerns have a high degree of accuracy in detecting developmental and behavioural problems and do so at levels that represent a substantial improvement over disability detection rates usually found in medical settings.